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This is a message from Dr Desai at The Old Courthouse Medical Practice. A clinical trial exploring treatment for the COVID-19 virus is taking place. If you experience a new or worsening continuous cough and/or a high temperature and have had it for less than 14 days and are not starting to feel better, please click to find out more. Please call the Trial Team if you have any questions or do not have access to online systems: 0800 138 0880

Registration with the practice

PreRegistration6 May 2020 

If you wish to register, at present we ask you to complete the registration form below (GMS1) which can be submitted to us and then the registration form Part 2 which you will need to download and fill out and return to us by email along with copies your proof of address and photo I.D.

If you wish to register click on the link below to open the form. When you have completed all of the details, click on the "Send" button to mail your form to us. We will then require you to  visit the surgery to confirm that the details are correct and complete some further information forms

Registration Form (GMS1) - Required for all adults, children and newborn babies. 

When you register you will also be asked to fill out a medical questionnaire. This is because it can take a considerable time for us to receive your medical records. There is an online version of this file too (Registration Form Part 2 see below) which you may fill out and send to us. When you come to the surgery you will be asked to sign this form to confirm that the details are correct.

Registration Form Part 2 - For Adults 18+ OVER 

Children's Registration Part 2 (17Y & UNDER) - Not required for newborn babies

Newborn Household Details - Please complete this if you are registering a newborn baby. 

Note that by sending the form you will be transmitting information about your self across the Internet and although every effort is made to keep this information secure, no guarantee can be offered in this respect.

Alternatively you may print off the registration forms, fill them out and bring them in to the surgery with the following documents: Passport, proof of address and red book for children under 6.

Registration Form (GMS1)

Registration Form Part 2

Children's Registration Part 2 (17Y & UNDER)

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